NPIMap

Individual provider Active NPI

Andrew William Fonderlin, RN

  • Certified Registered Nurse Anesthetist
  • Portland, ME
National Provider Identifier
1831941392
Registry record updated Aug 5, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
RNA243055 Issued in ME
Practice address
22 Bramhall St
Portland, ME 04102-3175
Phone
(207) 662-0111
NPI assigned
Apr 5, 2024
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 5, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Registered Nurse 163W00000X RN.459526 OH
Certified Registered Nurse Anesthetist 367500000X RNA243055 ME Primary

Addresses

Primary practice location

22 Bramhall St
Portland, ME 04102-3175

Mailing address

52 Hanover St Unit 604
Portland, ME 04101-5942
Phone (330) 469-0309

Other practice location 1

9500 Euclid Ave
Cleveland, OH 44195-0002
Phone (216) 444-2200

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ME

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240829002884 ME Practitioner - Certified Registered Nurse Anesthetist (Crna) 5991244212 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Certified Registered Nurse Anesthetist (Crna)
Education
Other, 2024
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
MainehealthGroup PAC ID 7517860588, 2,616 clinicians

Practice addresses (Care Compare)

22 Bramhall St
Portland, ME 04102-3134
Phone (207) 885-9905

84 Campus Dr
Scarborough, ME 04074-7133
Phone (207) 396-7000

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Registered Nurse

State licenses

LicenseStateTypeSpecialty
RN.459526OHMDRegistered Nurse
RNA243055MEMDCertified Registered Nurse Anesthetist

Practice roles

OrganizationSpecialtyStatusNew patients
Mainehealth CurrentSince Aug 12, 2024 Accepting new patients
Mainehealth Current Accepting new patients
Mainehealth CurrentSince Aug 12, 2024 Accepting new patients

Locations

22 Bramhall St
Portland, ME 04102
Phone (207) 662-2179

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 36

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 36

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1712275200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1722816000000",
    "number": "1831941392",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "52 HANOVER ST UNIT 604",
            "city": "PORTLAND",
            "state": "ME",
            "postal_code": "041015942",
            "telephone_number": "330-469-0309"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "22 BRAMHALL ST",
            "city": "PORTLAND",
            "state": "ME",
            "postal_code": "041023175",
            "telephone_number": "207-662-0111"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "9500 Euclid Ave",
            "address_purpose": "LOCATION",
            "city": "Cleveland",
            "state": "OH",
            "postal_code": "441950002",
            "country_code": "US",
            "telephone_number": "216-444-2200",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "FONDERLIN",
        "first_name": "ANDREW",
        "middle_name": "WILLIAM",
        "credential": "RN",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2024-04-05",
        "last_updated": "2024-08-05",
        "certification_date": "2024-07-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "OH",
            "license": "RN.459526",
            "primary": false
        },
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "ME",
            "license": "RNA243055",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Portland, ME

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 5, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.